© Copyright 2014. Healthtech Inc. All rights reserved.

Shared Electronic Health Record Implementation Journey Readiness AssessmentFebruary 28, 2018

Introductions

Terri LeFortPartner at Healthtech Consultants, Toronto, ON

Complete Lifecycle of eHealth and HCIS Services

CIS Tactical Planning

Optimization

Evaluation and Benefits Realization

CIS Implementation Services

Operational Support

Regional ICT Planning

System Procurement Services

Strategic & Operational Planning

Hospital Build & Redevelopment Virtual Health

Interim CIOIT Management

A Shared Electronic Health Record

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Benefits of a Shared Electronic Health Record

Providing accurate, up-to-date, and complete information about patients at the point of careSecurely sharing electronic information with patients and other clinicians eliminating the need for paper, faxes, phone calls, etc.Enabling safer, more reliable careReducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

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What is a Shared EHR?

A shared systemA shared clinical view of the patient’s record

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Required Standards in an Electronic Health Record

Sharing an EHR requires consistency in the collection and exchange of patient information

Standardization needs to focus on the output of information entry in the EHRStandards enhance quality of data; improve clinical care; support information sharing at transition points; increase patient safetyStandardization of terminology, practice and design of clinical system which includes standardization of workflow and clinical processes

TerminologyConsistent languageCommon nomenclatureStandardized scales e.g. pain scale (1-10)

Business Process and WorkflowConsistent implementation of language, nomenclature and standardized assessments and scales in practice

DesignCommon design which incorporates standardized, language, nomenclature, assessments and scales

Practice Evidence informed best practice

“Clinical documentation facilitates the accurate representation of a patient’s clinical status that translates into coded data. Coded data is then translated into quality reporting, statistical reporting, public health data, and disease tracking and trending”

AHIMA - http://www.ahima.org/topics/cdi?tabid=overview

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Impact of Clinical Content in the EHR

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EMR ID Pain Intensity

Organization A Documentation

Organization A Documentation

Impact of Clinical Content in the EHR

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IV / Invasive Line Assessment

Level of Standardization

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Strive/ Plan for a high level of standardizationComponents to be standardized:

Patient Data•Demographics•Patient Headers•Allergies•Medications•Health and Social History

Diagnostic Tests & Results•Lab•Diagnostics

Assessment and Exam Findings (Nursing and Allied Health)•Core Corporate Documentation Tools•Progress notes•Standardized Assessments•Speciality Documentation tools

Physician Documentation•Admission/H&P•Discharge Summary•Consultation Report•Progress Notes•Procedure Notes

Orders•Order Catalogue•General/Corporate Order Set

Care Planning•Consults/referrals•Discharge plans•Patient and family education•Problem Lists•Kardex

Shared EHR Readiness Assessment

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Vision …

is where you want to be, what you want to look like and when it will happen

provides direction, aligns key players, & energizes people to a common purpose

describes a future that reflects optimism but is realistic

stretches the imagination & motivates people to what is possible

Sharing The Vision

What is important for the organizations sharing an electronic health record?What will change with the introduction of a shared electronic health record?

What is the Vision?

Create a patient-entered interprofessional EHR to enable the co-ordination of care for patients in the NE LHINPatient-centered, fully adopted to provide a full patient view: equity of care, equal inpatient and outpatient services, core value of quality and safetyQuality, safe collaborative and evidence-based care across the continuum for patients in NE LHIN, supported by an integrated EMROne truth, one story for best outcomes throughout (my/the) healthcare journeyOne record, shared journey together

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Vision Statement

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VisionOne Person. One Record. One System - Transforming Clinical Quality, Through

Regional Care Standardization within a Unified Health Record.

Guiding Principles

Any principles or precepts that guide an organization throughout its life in all circumstances

Guiding Principles Sample

The primary goals of the shared standardized EMR are to improve patient safety and quality of care within each organization. Secondary goals include use of data for administrative; reporting; care and evaluation; patient and family engagement; and care planning.The collaboration will involve the standardization of documentation and processes wherever possible in the system utilizing a 80/20% rule unless patient risks and safety issues are identified. If risks and safety issues are identified, alternatives to standardization that meet the needs of both partners and the populations they serve will be determined. The EMR will facilitate and enhance opportunities for population health, business and clinical data analytics, teaching and research within and among the partners.Each organization has unique tactical needs that need to be met through an effective EMR support structure in accordance with a service level agreement.

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Governance

Governance is a priority In a shared project it is vital to project success

Well definedRoles and responsibilities need to be clear

Shared/Joint roles and responsibilities vs localDecision making

Clear processes and responsibilitiesEscalation process

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Implementation Governance Structure

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Executive Committee

PMOSite Leads

Finance & HRSteering

Committee

TechnicalSteering

Committee

ClinicalSteering

Committee

SeniorOversight

Management

SteeringCommittees

1. Billing2. Supply Chain3. Quality &

Analytics4. General Finance5. HR / Payroll

WorkingGroups

1. BAR2. MM/AP3. QRM/BCA4. GI/FA5. HR/PP, STS

BuildTeams

1. Reports2. Interoperability /

Conversions3. Architecture /

MIS / Technical

1. Med Mgmt2. Patient Access3. Pharmacy4. Lab5. ITS6. HIM

1. CWS/ADM2. PHA3. LAB4. ITS5. HIM/SCA

Clin Doc

1. EDM2. Surg3. Mental Health4. Paeds5. Mat Child

6. Medicine7. Allied Health

PAC

Order Sets

1. EDM2. SURG3. PCS4. EMR5. BMV

PCMOM

EMR Standards Committee

Note: the working groups have been consolidated in this illustration; each build team corresponds directly with a working group (e.g., Billing working group corresponds with BAR, Supply Chain working group with MM/AP, Quality & Analytics working group with QRM/BCA, etc.)

Order Set Subgroup

PDoc Subgroup

1. Reports2. Interfaces3. Conversions4. Architecture/MIS5. Technical

Roles and Responsibilities

Clearly definesWho does what?Shared/joint roles vs local

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Governance and Decision Making

Centralized designLocalized review and feedbackRegional approvalLocalized implementation

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©2017 Healthtech Consultants. All rights reserved. Do not distribute without written permission.

Decision Making Framework

The following matrix depicts suggested decision making process

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Working Groups/Design

Team

Site Specific Committees EMR Standards Clinical Systems

Steering

MEDITECH 6.1 Steering

Committee

System Set Up/Parameters Recommend Vet Vet/Endorse Approve Escalation

Corporate Clinical Content Recommend Vet/Recommend Vet/Endorse Approve Escalation

Program/Service Clinical Content Develop/Approve Vet/Recommend Vet/Endorse Escalation/Oversight Escalation

Timelines Recommend N/A N/A Recommend Approve

Budget Recommend N/A N/A Recommend Approve

Resources Recommend N/A N/A Recommend Approve

Risk Management Recommend Vet/Recommend N/A Approve Approve

Defined Scope

What’s in scope vs out of scopeChange process for ongoing decisions

Decision documents

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Change Management

Clinical Transformation Project NOT an IT ProjectAssess readiness for changeLocal change management strategy and tactical planShared change management strategy and tactical plan

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